Journal Issue: Childhood Obesity Volume 16 Number 1 Spring 2006
How Well Equipped Are Pediatricians to Handle "Adult" Diseases?
The typical medical complications of obesity, once confined to adulthood, are now emerging in childhood.49 During the past decade, pediatricians were confronted with unusual diseases like type 2 diabetes, nonalcoholic fatty liver disease, and polycystic ovary disorder.50 To slow or reverse the increase in childhood obesity and its associated health risks, it is necessary to treat childhood obesity as soon as it is detected. Given the limits to treating long-standing obesity, early pediatric interventions to limit excessive weight gain in preschool and preadolescent children appear to be the best way to tackle the problem. The most effective way to prevent complications of obesity in teenagers and adults is to introduce, model, and reinforce healthful behaviors and lifestyles early in childhood.
Because so many children suffer from overweight and obesity, such interventions are most appropriately based in the primary pediatric care setting, preferably with the support of registered dietitians and structured intervention programs. Especially when caring for the younger child, managing excessive weight gain should be the province of the primary care pediatrician. Although, as noted, few overweight children are now actively treated in the primary care setting and many are referred to specialists, the epidemic of childhood obesity and the paucity of pediatric obesity subspecialists have overwhelmed specialized treatment programs' capacities to handle the demand for their services.
Because almost all children receive their health care in primary care settings, developing effective and feasible strategies for preventing and treating childhood obesity in primary care settings offers an important opportunity for addressing this major public health problem. Giving the primary care provider a major role in preventing the onset of childhood obesity and in intervening promptly to correct excessive weight gain is critical. As noted, however, primary care pediatricians lack the training to care for obese patients. Few have time to assess, intervene, and monitor progress related to the child's dietary, behavioral, and physical activities, especially when the doctors are generally not reimbursed by third-party payers either to provide services themselves or to employ a multidisciplinary team within their practices to provide appropriate services.51 The clinical system is well prepared to treat acute conditions but not chronic conditions like obesity.